It’s now well established that Coronavirus causes problems in the brain whereas, initially it was all about the lungs. Stroke continues to be one of the leading causes of the disability in India and when the world is overwhelmed by the COVID-19 pandemic, it becomes even more important to understand the Neurological impact of the virus. It is still not clear but a part of it is due to lack of oxygen to the brain, however many other factors, such as problems with blood clotting and a heightened immune response and direct invasion by the virus in the brain have been implicated in stroke causation.
Q: Does Coronavirus infection put you at risk of having a brain stroke?
A: Yes, stroke has been seen as a manifestation of COVID-19 in various studies showing that 0.9% to 23% COVID-19 patients developed stroke. It has two types of presentations:
- Stroke in severely affected COVID-19 patients who initially develop COVID-19 symptoms and later on develop stroke as a multiorgan involvement.
- Few studies have shown that some patients present with stroke as an initial manifestation and later on found to have COVID-19, these are young patients without risk factors for brain stroke.
Q: What types of strokes are seen in COVID-19 patients?
A: Hemorrhagic stroke – rupture of a blood vessel leading to accumulation of blood in the brain, Ischemic stroke – blockage of a blood vessel leading to brain stroke due to lack of oxygen, CVT (Cerebral Venous Sinus Thrombosis) – blockage of veins in the brain leading to brain damage.
Q: What causes stroke in COVID-19 patients?
A: COVID-19 patients have a prothrombotic state which means they have a tendency for the blood to thicken or become sticky which blocks the blood vessels supplying the brain; and the blood supply of a particular part of the brain is cut off resulting in stroke symptoms. It can cause a shower of clots in different parts of the brain or clot can get lodged in one blood vessel and can lead to one territory stroke.
Q: How COVID-19 related stroke is different from stroke without COVID-19?
A: Traditional risk factors for stroke are uncontrolled blood pressure and diabetes, smoking, high cholesterol, sedentary lifestyle, atrial fibrillation, etc., patients suffering from these risk factors are more likely to suffer strokes but studies have shown Corona related strokes can happen without these risk factors also. Previously also viruses like Influenza and Herpes have been linked to heart attacks and brain stroke, however, the occurrence of stroke is more common in Corona infection as per the current literature.
Q: Does COVID related stroke happen only in the elderly?
A: Studies in the last six months have shown that stroke due to Coronavirus can happen in young patient’s i.e., who is less than 45 years of age. Young age does not offer protection against stroke; one study from New York had shown that young patients have a more severe stroke in the form of large-vessel involvement.
Q: How to know that someone is having a stroke?
A: Stroke can easily be identified by a four-letter word FAST (Sudden onset F – Facial weakness, A – Arm weakness, S – Speech problems, T – Don’t waste time at home). Reach the hospital within 4.5 hours of stroke onset as this is the only time when a stroke can be treated.
Q: Should the risk of infection prevent one from seeking timely stroke treatment?
A: Risk of acquiring COVID-19 should not delay life-saving stroke treatment which is time-dependent. Treatment like clot dissolution by injections – Thrombolysis, or Clot removal by Endovascular technique is effective only if a patient reaches the hospital early. Once, the brain damage has set in, it is not possible to completely reverse it. Best results are seen with early treatment.
Q: Why it is even more important to be stroke aware in COVID-19?
A: COVID-19 has already overwhelmed healthcare systems and delays can happen due to lack of transfer facilities as all the COVID designated hospitals may not be stroke ready. Further delays in rapid triage, screening, fear of patients to seek timely help make stroke treatment in COVID times more challenging.
Q: What stroke survivors need to do to prevent another stroke in this pandemic?
A: Take their medications for blood pressure, diabetes, high cholesterol, and blood thinners regularly. Those who are on OAC (Oral Anticoagulants) need regular monitoring of INR and continue their physiotherapy from home.
Take home message:
Stroke can be a presenting symptom of COVID-19, can happen in young people (< 45years) without traditional stroke risk factors, If a stroke is happening reach out to a stroke ready centre and don’t wait at home. Early treatment can help prevent the disability; “Time is Brain” every one-second delay in treatment can lead to 30,000 brain cell death.
Dr. Sahil Kohli | Consultant – Neurology | Narayana Superspeciality Hospital, Gurugram